New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/3/2024 6:28:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Moussa Shoueib
Notes:: AR 1.67 + Airlite

	SPH	CYL	AX	ADD
OD	-4.5	-0.75	160
OS	-3.5	-0.75	165

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS